How is it possible to place XL breast implants under the muscle?

Question

I've been researching if is possible to have implants 1000cc and over placed submuscular as these are huge implants, and I have found some women who have accomplished this. However, as muscle isn't as elastic as skin, I imagine, how is it possible to place something so large under the muscles? I want XL breast augmentation so the added support will be beneficial. With that said, wouldn't submuscular surgery limit my size options?

Kenneth Hughes, MD · Answer

Based upon your anatomy, there is a limit to the maximum size breast implant that can be placed submuscular. It is unreasonable to think that the largest and most compliant tissues could accommodate that.

James H. Rogers, MD · Answer

Without examing you , it is difficult to comment on how large an implant can be placed in either a submuscular or subglandular position. Certainly , in some patients this can readily be accomplished. In my practice , I do not recommend placement of implants on top of the muscle for a number of reasons. I also try to dissuade patients from having overly large implants placed at all. Most patients with extremely large implants for the available tissue coverage will experience increased problems with rippling, contour deformities , implant migration, and capsule contracture. When these problems occur , they can be quite challenging to correct with a good cosmetic result.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Depending on a patient's starting anatomy and breast size large implants can be placed underneath the muscle, but in most instances of 1000cc and greater the patients have pursued serial augmentations with progressively larger implants to reach that size.  Hope this helps.

Ronald J. Edelson, MD · Answer

1000 cc implants really stress that ability to be placed especially if your skin is tight.  An attempt can be made too place them under the muscle but the muscle will likely ride up and cover very little if the implant when all is said and done.  Going that large is a bad idea for several reasons and I strongly advise against it but don’t be surprised if many surgeons are more than happy to do it for you.

Donovan Rosas, MD · Answer

There are volume limits based on anatomy. There is only so much size that a breast envelope can accommodate. Occasionally, in cases where patients are seeking very large volumes, staged expansion may be employed or serial augmentation to gradually develop more space.That being said, I do caution against pursuing such large implants. The risk of complications increases with volume (with risks beginning to increase after 400-500 cc).As always, discuss your concerns with a board certified plastic surgeon (ABPS).Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic
Surgery, American Society of Plastic Surgeons
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Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  1000cc is a very large implant and I do not recommend it for most patients.  With extremely large implants, the complication risk of surgery is significantly higher.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results. Best wishes and good luck. Richard G. Reish, M.D.  FACS Harvard-trained plastic surgeon

Mark Soldin, MBChB · Answer

Once you have read up on the frequency of problems patients have to deal with when having very large implants, I hope you will decide to have a smaller augment. Very large implants give nothing but trouble.Consult with a BAAPS registered surgeon who will give sensible advice.

Connie Hiers, MD, FACS · Answer

Large implants can be placed under the muscle in some, but not all women. However, large implants, because of the weight, tend to sag and may fall out from under the muscle. This will then encourage even more sagging. You might consider going down in size. Over time, you will probably have fewer issues with implants that better fit your frame and don't overstretch your tissue. Big breasts sitting on your lap are not pretty.

Barry L. Eppley, MD, DMD · Answer

Many, if not all, women that have received breast implants of 1000cc or greater in the submuscular position have done so by employing the principle of tissue expansion. Meaning that they have first had smaller breast implant volumes placed which has allowed all overlying soft tissues to stretch including the muscle. Then secondarily the tissues can accommodate a 50% to 100% increase in implant volume. This also provides an opportunity to see whether a XL implant volume is really desired. But if so this approach provides a safer approach with a lower risk of complications.

Oliver Harley, FRCSEd(Plast) · Answer

Hi, thanks for your question.
unless you have a very large frame, 1000cc implants are really very big indeed. The average sized patient having this size of implant can expect an extremely unnatural look and feel from these along with significant stretching and deformation of the breast with time.  These would very likely commit you to ongoing cycles of breast implant exchange operations with the risks and expenses that go with this and I expect that you might never be truly happy.
Siting these implants in the under-breast or under-muscle plane would be technically demanding and possibly doomed to failure unless it is an implant exchange operation (i.e being placed in breasts that have already had quite large implants).  
best wishes

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